中国中老年人时变主客观健康不一致与新发抑郁的前瞻性队列研究

doi:10.3969/j.issn.1004-583X.2026.10.003

摘要/Abstract

摘要：

目的探讨中国中老年人群时变主客观健康表型与新发抑郁症状风险的前瞻性关联。方法基于中国健康与养老追踪调查(CHARLS,2011-2020年),纳入基线年龄≥50岁且无抑郁症状的受试者6 193人,共贡献15 892个人-周期。结合自评健康与慢性病共病界定4类时变表型,采用离散时间互补双对数生存模型分析风险。结果随访期间新发抑郁症状2 845例。全调整模型显示,相对于自评良好且无共病组,自评不良且无共病组(HR=1.54,95%CI:1.39~1.71)、自评良好伴共病组(HR=1.40,95%CI:1.14~1.71)和自评不良且伴共病组(HR=2.11,95%CI:1.88~2.36)风险均升高,交互检验均差异未达到统计学意义(P均>0.05)。结论时变主客观健康表型与新发抑郁症状风险相关,自评不良且伴共病者风险最高。联合评估主客观健康状况有助于识别高风险人群。

关键词: 自评健康, 慢性病共病, 健康不一致, 抑郁症状, 前瞻性队列研究

Abstract:

Objective To examine the prospective effect of time-updated discrepancies between subjective and objective health on incident depression in Chinese middle-aged and older adults. Methods Based on the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020), 6 193 middle-aged and older participants aged ≥50 years without depression at baseline were included (15 892 person-periods). Four time-updated phenotypes were defined by self-rated health and chronic disease comorbidity. A discrete-time complementary log-log survival model was used to evaluate the risk of depression. Results During follow-up, 2 845 incident depression cases occurred. In the fully adjusted model, compared with the group with good self-rated health and no comorbidity, the risk of incident depression was significantly increased in the group with poor self-rated health and no comorbidity (HR=1.54, 95%CI: 1.39-1.71), the group with good self-rated health but with comorbidity (HR=1.40, 95%CI: 1.14-1.71), and the group with poor self-rated health and comorbidity (HR=2.11, 95%CI: 1.88-2.36). No significant interactions were observed across clinical subgroups (all interaction P>0.05). Conclusion Health phenotypes were associated with incident depressive symptoms; the highest risk was observed among individuals with both poor self-rated health and multimorbidity. Joint evaluation of subjective and objective health may help identify individuals at elevated risk of depressive symptoms.

Key words: self-rated health, chronic disease multimorbidity, health discordance, depressive symptoms, prospective cohort study

中图分类号:

R749.4
R592

王启龙, 齐鑫, 赵东荣. 中国中老年人时变主客观健康不一致与新发抑郁的前瞻性队列研究[J]. 临床荟萃, 2026, 41(10): 881-890.

Wang Qilong, Qi Xin, Zhao Dongrong. A prospective cohort study of time-updated discrepancies between subjective and objective health and incident depressive symptoms in Chinese middle-aged and older adults[J]. Clinical Focus, 2026, 41(10): 881-890.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.10.003

https://www.lchc.cn/CN/Y2026/V41/I10/881

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参考文献 30

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特征指标		总体 (N=6157)		自评良好-无共病 (n=1 614)		自评不良-无共病 (n=3 242)		自评良好-伴共病 (n=202)	自评不良-伴共病 (n=1099)	统计量		P值
例数[例(%)]		6 157(100.0)		1 614(26.2)		3 242(52.7)		202(3.3)	1 099(17.8)	-		-
年龄(岁)		61.5±7.9		60.7±7.7		61.2±7.8		63.5±8.8	63.4±7.7	F=34.60		<0.001
年龄分段[例(%)]										χ²=81.43		<0.001
<65岁		4 230(68.7)		1 182(73.2)		2 285(70.5)		120(59.4)	643(58.5)
≥65岁		1 927(31.3)		432(26.8)		957(29.5)		82(40.6)	456(41.5)
性别[例(%)]										χ²=27.65		<0.001
男		2 764(44.9)		660(40.9)		1 446(44.6)		100(49.5)	558(50.8)
女		3 393(55.1)		954(59.1)		1 796(55.4)		102(50.5)	541(49.2)
受教育程度[例(%)]										χ²=17.21		0.009
初中及以下		5 359(87.0)		1 371(84.9)		2 847(87.8)		173(85.6)	968(88.1)
高中/中专		676(11.0)		203(12.6)		343(10.6)		20(9.9)	110(10.0)
大专及以上		122(2.0)		40(2.5)		52(1.6)		9(4.5)	21(1.9)
家庭人均年收入[例(%)]										χ²=32.57		<0.001
低收入组		2 058(33.4)		514(31.8)		1 125(34.7)		59(29.2)	360(32.8)
中等收入组		2 052(33.3)		507(31.4)		1 134(35.0)		55(27.2)	356(32.4)
高收入组		2 047(33.2)		593(36.7)		983(30.3)		88(43.6)	383(34.8)
在业状态[例(%)]										χ²=150.06		<0.001
非在业		2 306(37.5)		525(32.5)		1 110(34.2)		86(42.6)	585(53.2)
在业		3 851(62.5)		1 089(67.5)		2 132(65.8)		116(57.4)	514(46.8)
婚姻状况[例(%)]										χ²=10.96		0.012
无伴侣(离异/丧偶/未婚)		661(10.7)		179(11.1)		314(9.7)		23(11.4)	145(13.2)
已婚/有伴侣		5 496(89.3)		1 435(88.9)		2 928(90.3)		179(88.6)	954(86.8)
与子女同住情况[例(%)]										χ²=11.74		0.008
否		2 696(43.8)		714(44.2)		1 367(42.2)		104(51.5)	511(46.5)
是		3 461(56.2)		900(55.8)		1 875(57.8)		98(48.5)	588(53.5)
体质量指数(BMI, kg/m²)		23.6±3.7		23.6±3.6		22.9±3.6		25.2±3.9	25.0±4.0	F=102.60		<0.001
体质量分类[例(%)]										χ²=225.49		<0.001
正常(18.5~23.9)		3 260(52.9)		869(53.8)		1 900(58.6)		74(36.6)	417(37.9)
消瘦(<18.5)		353(5.7)		72(4.5)		228(7.0)		6(3.0)	47(4.3)
超重/肥胖(≥24.0)		2 544(41.3)		673(41.7)		1 114(34.4)		122(60.4)	635(57.8)
吸烟状况[例(%)]											χ²=44.43	<0.001
否	4 083(66.3)		1 029(63.8)		2 091(64.5)		146(72.3)		817(74.3)
是	2 074(33.7)		585(36.2)		1 151(35.5)		56(27.7)		282(25.7)
饮酒状况[例(%)]											χ²=50.94	<0.001
否	3 936(63.9)		933(57.8)		2 088(64.4)		135(66.8)		780(71.0)
是	2 221(36.1)		681(42.2)		1 154(35.6)		67(33.2)		319(29.0)
高血压[例(%)]											χ²=1 889.99	<0.001
否	4 525(73.5)		1 412(87.5)		2 771(85.5)		48(23.8)		294(26.8)
是	1 632(26.5)		202(12.5)		471(14.5)		154(76.2)		805(73.2)
心脏病[例(%)]											χ²=1 426.44	<0.001
否	5 478(89.0)		1 583(98.1)		3 114(96.1)		142(70.3)		639(58.1)
是	675(11.0)		31(1.9)		128(3.9)		60(29.7)		456(41.5)
糖尿病[例(%)]											χ²=699.89	<0.001
否	5 760(93.6)		1 589(98.5)		3 168(97.7)		153(75.7)		850(77.3)
是	383(6.2)		25(1.5)		74(2.3)		47(23.3)		237(21.6)
脑卒中[例(%)]											χ²=312.72	<0.001
否	6 029(97.9)		1 607(99.6)		3 229(99.6)		190(94.1)		1 003(91.3)
是	126(2.0)		7(0.4)		13(0.4)		12(5.9)		94(8.6)
慢性肺部疾患[例(%)]											χ²=503.90	<0.001
否	5 610(91.1)		1 555(96.3)		3 074(94.8)		163(80.7)		818(74.4)
是	543(8.8)		59(3.7)		168(5.2)		39(19.3)		277(25.2)
恶性肿瘤[例(%)]											χ²=64.86	<0.001
否	6 089(98.9)		1 610(99.8)		3 223(99.4)		196(97.0)		1 060(96.5)
是	61(1.0)		4(0.2)		19(0.6)		5(2.5)		33(3.0)
关节炎/风湿病[例(%)]											χ²=1 024.91	<0.001
否	4 388(71.3)		1 398(86.6)		2 517(77.6)		78(38.6)		395(35.9)
是	1 769(28.7)		216(13.4)		725(22.4)		124(61.4)		704(64.1)
累积慢性病种数[例(%)]											χ²=6 291.62	<0.001
0种	2 714(44.1)		1 070(66.3)		1 644(50.7)		0(0)		0(0.8)
1种	2 142(34.8)		544(33.7)		1 598(49.3)		0(0)		0(0)
≥2种	1 301(21.1)		0(0.0)		0(0.0)		202(100.0)		1 099(100.0)
基线CES-D-10评分(分)	4.5±2.8		3.5±2.7		4.7±2.7		3.9±2.8		5.1±2.7		F=92.40	<0.001

特征指标		总体 (N=6157)		自评良好-无共病 (n=1 614)		自评不良-无共病 (n=3 242)		自评良好-伴共病 (n=202)	自评不良-伴共病 (n=1099)	统计量		P值
例数[例(%)]		6 157(100.0)		1 614(26.2)		3 242(52.7)		202(3.3)	1 099(17.8)	-		-
年龄(岁)		61.5±7.9		60.7±7.7		61.2±7.8		63.5±8.8	63.4±7.7	F=34.60		<0.001
年龄分段[例(%)]										χ²=81.43		<0.001
<65岁		4 230(68.7)		1 182(73.2)		2 285(70.5)		120(59.4)	643(58.5)
≥65岁		1 927(31.3)		432(26.8)		957(29.5)		82(40.6)	456(41.5)
性别[例(%)]										χ²=27.65		<0.001
男		2 764(44.9)		660(40.9)		1 446(44.6)		100(49.5)	558(50.8)
女		3 393(55.1)		954(59.1)		1 796(55.4)		102(50.5)	541(49.2)
受教育程度[例(%)]										χ²=17.21		0.009
初中及以下		5 359(87.0)		1 371(84.9)		2 847(87.8)		173(85.6)	968(88.1)
高中/中专		676(11.0)		203(12.6)		343(10.6)		20(9.9)	110(10.0)
大专及以上		122(2.0)		40(2.5)		52(1.6)		9(4.5)	21(1.9)
家庭人均年收入[例(%)]										χ²=32.57		<0.001
低收入组		2 058(33.4)		514(31.8)		1 125(34.7)		59(29.2)	360(32.8)
中等收入组		2 052(33.3)		507(31.4)		1 134(35.0)		55(27.2)	356(32.4)
高收入组		2 047(33.2)		593(36.7)		983(30.3)		88(43.6)	383(34.8)
在业状态[例(%)]										χ²=150.06		<0.001
非在业		2 306(37.5)		525(32.5)		1 110(34.2)		86(42.6)	585(53.2)
在业		3 851(62.5)		1 089(67.5)		2 132(65.8)		116(57.4)	514(46.8)
婚姻状况[例(%)]										χ²=10.96		0.012
无伴侣(离异/丧偶/未婚)		661(10.7)		179(11.1)		314(9.7)		23(11.4)	145(13.2)
已婚/有伴侣		5 496(89.3)		1 435(88.9)		2 928(90.3)		179(88.6)	954(86.8)
与子女同住情况[例(%)]										χ²=11.74		0.008
否		2 696(43.8)		714(44.2)		1 367(42.2)		104(51.5)	511(46.5)
是		3 461(56.2)		900(55.8)		1 875(57.8)		98(48.5)	588(53.5)
体质量指数(BMI, kg/m²)		23.6±3.7		23.6±3.6		22.9±3.6		25.2±3.9	25.0±4.0	F=102.60		<0.001
体质量分类[例(%)]										χ²=225.49		<0.001
正常(18.5~23.9)		3 260(52.9)		869(53.8)		1 900(58.6)		74(36.6)	417(37.9)
消瘦(<18.5)		353(5.7)		72(4.5)		228(7.0)		6(3.0)	47(4.3)
超重/肥胖(≥24.0)		2 544(41.3)		673(41.7)		1 114(34.4)		122(60.4)	635(57.8)
吸烟状况[例(%)]											χ²=44.43	<0.001
否	4 083(66.3)		1 029(63.8)		2 091(64.5)		146(72.3)		817(74.3)
是	2 074(33.7)		585(36.2)		1 151(35.5)		56(27.7)		282(25.7)
饮酒状况[例(%)]											χ²=50.94	<0.001
否	3 936(63.9)		933(57.8)		2 088(64.4)		135(66.8)		780(71.0)
是	2 221(36.1)		681(42.2)		1 154(35.6)		67(33.2)		319(29.0)
高血压[例(%)]											χ²=1 889.99	<0.001
否	4 525(73.5)		1 412(87.5)		2 771(85.5)		48(23.8)		294(26.8)
是	1 632(26.5)		202(12.5)		471(14.5)		154(76.2)		805(73.2)
心脏病[例(%)]											χ²=1 426.44	<0.001
否	5 478(89.0)		1 583(98.1)		3 114(96.1)		142(70.3)		639(58.1)
是	675(11.0)		31(1.9)		128(3.9)		60(29.7)		456(41.5)
糖尿病[例(%)]											χ²=699.89	<0.001
否	5 760(93.6)		1 589(98.5)		3 168(97.7)		153(75.7)		850(77.3)
是	383(6.2)		25(1.5)		74(2.3)		47(23.3)		237(21.6)
脑卒中[例(%)]											χ²=312.72	<0.001
否	6 029(97.9)		1 607(99.6)		3 229(99.6)		190(94.1)		1 003(91.3)
是	126(2.0)		7(0.4)		13(0.4)		12(5.9)		94(8.6)
慢性肺部疾患[例(%)]											χ²=503.90	<0.001
否	5 610(91.1)		1 555(96.3)		3 074(94.8)		163(80.7)		818(74.4)
是	543(8.8)		59(3.7)		168(5.2)		39(19.3)		277(25.2)
恶性肿瘤[例(%)]											χ²=64.86	<0.001
否	6 089(98.9)		1 610(99.8)		3 223(99.4)		196(97.0)		1 060(96.5)
是	61(1.0)		4(0.2)		19(0.6)		5(2.5)		33(3.0)
关节炎/风湿病[例(%)]											χ²=1 024.91	<0.001
否	4 388(71.3)		1 398(86.6)		2 517(77.6)		78(38.6)		395(35.9)
是	1 769(28.7)		216(13.4)		725(22.4)		124(61.4)		704(64.1)
累积慢性病种数[例(%)]											χ²=6 291.62	<0.001
0种	2 714(44.1)		1 070(66.3)		1 644(50.7)		0(0)		0(0.8)
1种	2 142(34.8)		544(33.7)		1 598(49.3)		0(0)		0(0)
≥2种	1 301(21.1)		0(0.0)		0(0.0)		202(100.0)		1 099(100.0)
基线CES-D-10评分(分)	4.5±2.8		3.5±2.7		4.7±2.7		3.9±2.8		5.1±2.7		F=92.40	<0.001

健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	模型1		模型2		模型3
健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	HR(95%CI)	P值	HR(95%CI)	P值	HR(95%CI)	P值
自评良好-无共病(参照组)	4 265	514	12.05	1.00[参照]	-	1.00[参照]	-	1.00[参照]	-
自评不良-无共病	7 473	1 419	18.99	1.63(1.47~1.80)	<0.001	1.60(1.45~1.77)	<0.001	1.54(1.39~1.71)	<0.001
自评良好-伴共病	754	120	15.92	1.37(1.13~1.68)	0.002	1.32(1.08~1.61)	0.007	1.40(1.14~1.71)	0.001
自评不良-伴共病	3 400	792	23.29	2.08(1.86~2.33)	<0.001	2.01(1.79~2.25)	<0.001	2.11(1.88~2.36)	<0.001

健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	模型1		模型2		模型3
健康不一致表型 (第t波)	人-周期数	新发抑郁事件数	粗发病率 (%)	HR(95%CI)	P值	HR(95%CI)	P值	HR(95%CI)	P值
自评良好-无共病(参照组)	4 265	514	12.05	1.00[参照]	-	1.00[参照]	-	1.00[参照]	-
自评不良-无共病	7 473	1 419	18.99	1.63(1.47~1.80)	<0.001	1.60(1.45~1.77)	<0.001	1.54(1.39~1.71)	<0.001
自评良好-伴共病	754	120	15.92	1.37(1.13~1.68)	0.002	1.32(1.08~1.61)	0.007	1.40(1.14~1.71)	0.001
自评不良-伴共病	3 400	792	23.29	2.08(1.86~2.33)	<0.001	2.01(1.79~2.25)	<0.001	2.11(1.88~2.36)	<0.001

亚组分类	分层水平	健康不一致表型	人-周期数	新发抑郁 (例)	发病率 (%)	HR(95%CI)	P值	交互P值
性别	男性	自评不良-无共病	3 200	731	22.84	1.41(1.16~1.71)	<0.001	0.506
		自评良好-伴共病	359	66	18.38	1.26(0.87~1.82)	0.215	0.222
		自评不良-伴共病	1 604	414	25.81	1.75(1.41~2.16)	<0.001	0.127
	女性	自评不良-无共病	4 273	688	16.10	1.52(1.26~1.85)	<0.001	0.506
		自评良好-伴共病	395	54	13.67	1.68(1.17~2.41)	0.005	0.222
		自评不良-伴共病	1 796	378	21.05	2.14(1.72~2.65)	<0.001	0.127
年龄	<65岁	自评不良-无共病	5 456	1 047	19.19	1.50(1.28~1.77)	<0.001	0.573
		自评良好-伴共病	454	78	17.18	1.52(1.09~2.11)	0.013	0.509
		自评不良-伴共病	2 206	511	23.16	1.92(1.60~2.32)	<0.001	0.758
	≥65岁	自评不良-无共病	2017	372	18.44	1.36(1.07~1.74)	0.014	0.573
		自评良好-伴共病	300	42	14.00	1.32(0.88~1.99)	0.186	0.509
		自评不良-伴共病	1 194	281	23.53	1.89(1.46~2.45)	<0.001	0.758
家庭人均年收入	低收入组	自评不良-无共病	1 622	353	21.76	1.35(1.09~1.67)	0.005	0.316
		自评良好-伴共病	148	27	18.24	1.23(0.79~1.90)	0.354	0.404
		自评不良-伴共病	719	205	28.51	1.88(1.49~2.38)	<0.001	0.910
	中高收入组	自评不良-无共病	3062	564	18.42	1.56(1.30~1.86)	<0.001	0.316
		自评良好-伴共病	350	53	15.14	1.54(1.12~2.12)	0.008	0.404
		自评不良-伴共病	1 562	338	21.64	1.94(1.60~2.37)	<0.001	0.910
受教育程度	初中及以下	自评不良-无共病	6558	1 291	19.69	1.42(1.23~1.63)	<0.001	0.093
		自评良好-伴共病	645	109	16.90	1.40(1.07~1.83)	0.013	0.458
		自评不良-伴共病	2 917	721	24.72	1.89(1.62~2.21)	<0.001	0.602
	高中及以上	自评不良-无共病	915	128	13.99	2.45(1.40~4.29)	0.002	0.093
		自评良好-伴共病	109	11	10.09	2.09(0.85~5.18)	0.109	0.458
		自评不良-伴共病	483	71	14.70	2.64(1.41~4.93)	0.002	0.602
与子女同住情况	未同住	自评不良-无共病	3132	567	18.10	1.40(1.15~1.70)	<0.001	0.458
		自评良好-伴共病	345	56	16.23	1.40(0.96~2.03)	0.078	0.943
		自评不良-伴共病	1 548	360	23.26	1.84(1.48~2.28)	<0.001	0.867
	同住	自评不良-无共病	4 180	812	19.43	1.52(1.26~1.84)	<0.001	0.458
		自评良好-伴共病	396	61	15.40	1.47(1.03~2.11)	0.034	0.943
		自评不良-伴共病	1 789	423	23.64	2.04(1.64~2.52)	<0.001	0.867